The European directive on patients' rights

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Directive No. 2011/24/EU of March 9, 2011 on patients' rights in cross-border healthcare aims to guarantee patient mobility and the free provision of healthcare services.

It has been applicable in the European member States since October 25, 2013, and in the European Economic Area* (Iceland, Liechtenstein, and Norway) since August 1st, 2015. However, it does not apply to Switzerland.

Background information

The European Union's coordination rules guarantee that an insured individual who travels within the European Union will receive the same healthcare as if s/he were a member of the healthcare system of the State in which treatment is provided.

Coordination regulations (EC) Nos. 883/04 and 987/09 entitle insured individuals to receive healthcare elsewhere within the European Union or the European Economic Area (Iceland, Liechtenstein, and Norway), as well as in Switzerland, and be covered for the care received by their home country's healthcare system according to that system's specific guidelines.

Legal precedent from the European Court of Justice has subsequently reinforced patients' rights. Indeed, by taking account of legal precedent ( Kohll, Decker, Smits and Peerbooms, and Watts rulings), the directive reaffirms the principle of free movement of people.

This directive includes social security coordination rules which work together with those provided by (CE) regulations Nos. 883 and 987.

Content of the directive

The Directive aims to facilitate access to safe, high-quality cross-border healthcare and to promote healthcare-related cooperation between EU and EEA (Iceland, Liechtenstein, and Norway) member States, while maintaining each State's independent authority to organize and provide healthcare services:

People covered

The directive covers all European Union citizens, as well as residents who are citizens of other countries and meet certain criteria.

When applied to the EEA member states (Iceland, Liechtenstein, and Norway), the directive does not cover citizens of other countries. Indeed, these States have not ratified EU Regulation N° 1231/2010 of the European Parliament and of the Council of 24 November 2010 extending Regulation (EC) No 883/2004 and Regulation (EC) No 987/2009 to nationals of third countries who are not already covered by these Regulations solely on the ground of their nationality.

The directive refers to the concept of "the patient" rather than the "insured" as is the case in the European coordination regulations.

Healthcare covered

The directive covers all healthcare provided or prescribed in a member State that is not the State of affiliation. It also covers the prescription and delivery of medications and medical devices which are supplied as part of the healthcare being received.

The directive does not apply to:

Healthcare providers covered

The directive covers all healthcare providers legally practicing medicine (public or private, whether or not they charge government-regulated fees), and regardless of whether the services they provide are "reimbursable."

Transposition into French law

The criteria for and details of how medical care is reimbursed, as provided by regulations Nos. 883/04 and 987/09, which currently cover patients who receive care in another European Union or EEA country or Switzerland, remain applicable.
The directive adds on to the current system by incorporating ECJ legal precedent and by bolstering patients' rights when it comes to information and to the quality and safety of care.
The rules for coverage of care are set forth by articles R 160-1 et seq of the French social security code:

The provisions of the directive pertaining to the recognitions of prescriptions written in another EU member State have been transposed into French law by decrees No. 2013-1216 of December 23, 2013 (medications) and No. 2014-1525 of December 27, 2014 (medical devices).

French Law No. 2014-201 of February 24, 2014, which brings various aspects of French health-related law into line with European law, requires persons authorized to use the titles of "chiropractor" and "osteopath" to take out specific insurance.

Decree No. 2015-223 of February 26, 2015 pertaining to the setup and revised roles of the Cleiss, designates the latter as France's National Contact Point as defined by directive No. 2011/24/EU.

How the directive works together with regulation No. 883/2004

The directive mainly applies to ambulatory care, whether or not it is scheduled. Unforeseen or emergency care covered by the EHIC remains within the scope of (EC) regulations Nos. 883/04 and 987/09.

This means that the scopes of (EC) regulation No. 883/2004 and directive No. 2011/24/EC coexist and are complementary. A comparison of the healthcare system in the country of affiliation and that of the country where care is received will determine whether the directive or the regulation applies.

(EC) regulation No. 883/2004:

Directive No. 2011/24/EU: